1. www.pspbc.ca Advanced Access & Office Efficiency Learning Session 1 Fall, 2010

2. 2  At the end of today’s session, participants will: › be able to describe advanced access and how it can benefit their practice › understand a process for trying small changes to improve access in their practice › have a plan for trying some small changes over the next couple of months Welcome

3. 3  GPSC › who, what, why  Practice Support Program (PSP) › Who, what, why › Reimbursement › Accreditation – Main Pro C, Main Pro M1 GPSC and PSP

4. 4  All systems work best when they work without a delay  Delays exist in family practices when patients are waiting for an appointment and while waiting at an appointment  Reducing these delays has benefits of: ›  Clinical outcomes for patients ›  Satisfaction of patients, physicians and staff ›  Costs ›  Revenue ›  Patient/provider relationship Introduction

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6. 6 The care of patients will be redesigned to improve access, capacity and efficiency. How will the aim be accomplished? Advanced Access, and Office Efficiency change packages will be use to decrease the wait time of patients for, and at, appointments in Primary Care How will we know this has been accomplished? Change will be evidenced by improved 3rd next available appointment, and improved appointment cycle time. Collaborative Aim

7. 7 Collaborative Measures Delay for appointment Cycle times Patient experience – Access Patient experience – Office Efficiency Provider and staff experience

8. 8  Physician: “I can do all of today’s work today.”  Patients: “I get the care I need when I need it.” Advanced Access

9. 9  Seeing your own patients when they need and want to be seen  Eliminating delays for an appointment  Evidence-based What is Advanced Access?

10. 10  Ensuring you see more patients  Carving out time in your already full schedule  Asking patient to call back the next day to schedule an appointment on “same day”  A government plot to make physicians work harder! What Advanced Access is not!

11. 11 My experience – Dr. ______________ Before advanced access:  Patient care  Physician quality of life  MOA quality of life  Financial e.g. walk-in losses  Delay  No shows  Patient dissatisfaction

12. 12  After advanced access:  Improved patient care: “I can do all of today’s work today” › Reduction in delay for appointments  Improved physician quality of life › Leave on time › Efficient appointments › Fewer patient “lists”  Improved MOA quality of work life › Less time on the phone › Less negotiating with patient  Financial My experience

13. 13 Key concepts of Advanced Access  Understand, measure and balance your supply and demand  Work down your backlog  Reduce your scheduling complexity  Develop contingency plans

14. 14 1. Understanding Supply and Demand panel: creates real work Waiting: work waiting to be addressed (backlog)  Delays If S < D: reservoir fills, backlog builds up, delays  Waiting reservoir Demand (patient panel) Supply (Number of appointments available)

15. 15  Requests for appointments  External – patient driven  Internal – practice driven What is demand?

16. 16  The number of appointment slots available in a given day  Supply is what you have in your schedule to meet your demand. What is supply?

17. 17  Reduce demand  Increase supply Supply:Demand Demand Supply

18. 18  Delay  Demand  Supply  Panel size › Physician profile report › Billing Measures

19. 19  To measure the delay for appointments and to correct for  cancellations we use the third next available appointment  Next available appt:(could be cancellation)  2nd next available appt :(could be cancellation)  3rd next available appt:(measure of access)  Measure the number of days to the 3rd next? Measuring delays

20. 20  Record every request for an appointment  Include appointment requests from all sources  Count demand on the day the request comes in regardless of when the appointment date is scheduled  Track demand daily Measuring demand

21. 21 Tool to measure demand

22. 22  Choose a typical week in the future. Avoid weeks before, during and immediately after holidays  Count every available appointment slot each day and record it  If there are predefined double slots, count them as two  If there is more than one physician, count for each of them separately Measuring supply

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24. 24 Schedules 100% booked “Do yesterdays work today.” Traditional modelExample of an Advanced access model “Do today’s work today.” 65% open 35% booked

25. 25  What is meant by “Backlog”?  The total work that is waiting for you between today and the third next available appointment  Types of backlog:  Good backlog: › Appropriate follow up › Planned future visits  Bad back log: › Today’s work pushed to the future – appointments requested for today that could not be accommodated today › Scheduled appointments that may be unnecessary 2. Reducing the Backlog (the reservoir)

26. 26 Calculating backlog

27. 27  Review the measurement tools  Review your schedule  Assess backlog Activity

28. 28  Review schedule & push ahead some good backlog  Review schedule & deal with any appointments via phone or email, if possible  Temporarily increase hours › Schedule a couple of extra appointment slots/day › Add another day or half-day if not working full time Strategies for Reducing Backlog

29. 29  Review call back standards or policies › Prescription renewal › Chronic disease/multiple follow-ups  Bring in locum or share/overlap with other physicians or practices Reducing the Backlog

30. 30  Reduce appointment types  Use “truth in scheduling”  Review and revise scheduling “rules” 3. Reducing scheduling complexity

31. 31 4. Contingency Planning  Planning for time out of office anticipated or unanticipated

32. 32 “Freeze/Unfreeze Strategy” Before holiday begins: – freeze all appointment slots for physician’s 1 st week back (1 st week back) …/

33. 33 Freeze/Unfreeze Strategy …/ (1 st week back) MOA will continue to unfreeze mornings on a day-by-day basis … On Monday of the last week of holiday, open the schedule for the Monday morning of the 1 st week back

34. 34 Freeze/Unfreeze Strategy (1 st week back) MOA will continue to unfreeze afternoons on a day-by-day basis … On the Monday of the 1 st week back, open the afternoon appointments for that same Monday

35. 35 Break

36. 36  An evidence based approach to making sustainable changes  Involves finding the answers to the following questions: › What are we trying to accomplish (Aims)? › How do we know change is an improvement (Measures)? › What changes can we make that will result in an improvement (Tests of change)? The Model for Improvement

37. 37 What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in improvement? Model for Improvement ActPlan StudyDo

38. 38 MeasuresTarget Current (Baseline) Practice Aim Delay for appointment Able to offer same day, if requested Cycle times [practice & context specific] __ minutes% improvement Patient experience – Office Efficiency (1) 80% answer “most of the time” % Patient experience – Access (2) 80% answer “Very easy” % Provider and staff experience (3) 80% answer “most of the time” % “When you visit your doctor’s office, how often is it well organized, efficient, and does not waste your time?” “How easy is it for you to see your family physician when you need to?” “I start and end my day on time.”

39. 39 Try a few small tests of change… Aim: To reduce the number of appt. types to short and long Reduction of types down to long and short? AP SD D S P A DATA D S P A Cycle 1: Pick one morning in the next week to appoint patients into short or long appointment types. Did the appointments start and end on time? Cycle 2: Choose a week in the future to book appointments according to short and long time slots. Was it easy to book this way? Cycle3: Pick a future day in the schedule just beyond the 3 rd next available, and start booking by short and long time slots.

40. 40 Where do I start?  What are you going to do next Tuesday?  What is your aim?  Determine how you will measure/track improvement

41. 41  What do you tell patients about your changes?  How will you get the message across? (brochures, posters, etc)  Use of the MOA “script” Patient considerations

42. 42  Timeframe  RST Support  Data/measures Action Period

43. Good Luck!